<form action="{{ action }}" method="get">
  <input type="hidden" name="mid" value="{{ mid }}"/> <input type="hidden" name="amt" value="{{ amt }}"/> <input type="hidden" name="amt_editable" value="N"/> <input type="hidden" name="currency" value="{{ currency }}"/> <input type="hidden" name="ref" value="{{ ref }}"/> <input type="hidden" name="pmt_sender_email" value="{{ pmt_sender_email }}"/> <input type="hidden" name="pmt_contact_firstname" value="{{ pmt_contact_firstname }}"/> <input type="hidden" name="pmt_contact_surname" value="{{ pmt_contact_surname }}"/> <input type="hidden" name="pmt_contact_phone" value="{{ pmt_contact_phone }}"/> <input type="hidden" name="pmt_country" value="{{ pmt_country }}"/> <input type="hidden" name="regindi_address1" value="{{ regindi_address1 }}"/> <input type="hidden" name="regindi_address2" value="{{ regindi_address2 }}"/> <input type="hidden" name="regindi_sub" value="{{ regindi_sub }}"/> <input type="hidden" name="regindi_state" value="{{ regindi_state }}"/>
  <input type="hidden" name="regindi_pcode" value="{{ regindi_pcode }}"/> <input type="hidden" name="return" value="{{ return }}"/> <input type="hidden" name="popup" value="false"/>
  <div class="d-inline-block pt-2 pd-2 w-100">
    <div class="float-right"><button type="submit" class="btn btn-primary">{{ button_confirm }}</button></div>
  </div>
</form>
